The patient was diagnosed with triple-negative breast cancer (TNBC) after a biopsy conducted by another surgeon.
Bengaluru (Karnataka) [India] October 11: Breast cancer continues to rise as a significant health issue in India, with over 200,000 new cases diagnosed annually as of 2024. Nearly 50% of these cases are detected in advanced stages, which significantly affects survival rates. Early detection and advanced treatments, such as robotic surgery, are critical in improving patient outcomes and offering hope to those with more complex diagnoses. Innovative surgical options, particularly in cases involving advanced or aggressive forms of breast cancer, are now playing a pivotal role in improving both survival rates and quality of life. The innovative surgical procedure performed by Dr. Nayak now offers hope for patients seeking cancer treatment in Bangalore, particularly for complex cases like TNBC that demand a combination of surgical precision and comprehensive post-surgical care.
In this context, the following case highlights a pioneering use of robotic nipple-sparing mastectomy (NSM) with immediate reconstruction, marking the first totally robotic NSM with natural tissue reconstruction in India
A 33-year-old young mother presented with a large mass in her left breast, previously biopsied and confirmed as cancerous. This case highlights the innovative use of robotic nipple-sparing mastectomy (NSM) and immediate reconstruction in managing breast cancer. The procedure marks the first reported case of a totally robotic NSM with reconstruction using a flap in India, demonstrating a significant advancement in breast cancer care.
The patient was diagnosed with triple-negative breast cancer (TNBC) after a biopsy conducted by another surgeon. Following her referral to Dr. Sandeep Nayak, further diagnostic tests, including immunohistochemistry (IHC), confirmed the aggressive subtype of breast cancer.
TNBC is known for its lack of hormone receptor targets, which makes it resistant to certain therapies that work on hormone-driven breast cancers. This subtype, typically associated with a higher risk of recurrence, required a highly personalized and aggressive treatment approach.
The IHC tests confirmed the TNBC diagnosis, and the team at MACS Clinic developed a treatment strategy that reflected the aggressive nature of the disease. The patient was placed on Total Neoadjuvant ChemoTherpay (TNT) before surgery, a regimen designed to shrink the tumour and address any micrometastases. This approach was particularly critical in ensuring that the tumour became operable, reducing its size while potentially increasing the chance for successful long-term outcome. The patient’s remarkable response to the TNT regimen allowed for a more controlled and targeted surgical approach.
Given the multicentric nature of her cancer, a mastectomy (removal of entire breast) was deemed necessary. Typically, a modified radical mastectomy (MRM) would be performed in such cases, involving the removal of the entire breast, including the nipple and areola. However, the patient expressed concern about her body image, which is a common challenge for younger breast cancer patients. She was reluctant to proceed with traditional mastectomy methods, including external breast prostheses or silicone implants, which led Dr. Sandeep Nayak to propose a cutting-edge solution: robotic nipple-sparing mastectomy (NSM) combined with immediate reconstruction using a robotic latissimus dorsi (LD) flap. This novel approach to cancer treatment provided the dual benefits of effective cancer removal while preserving the nipple and skin over breast, and achieving a more natural breast reconstruction.
During the surgery, which lasted approximately eight hours, a minimally invasive 5 cm incision was made in the patient’s breast, allowing for optimal aesthetic outcomes. The procedure also included a robotic axillary lymph node dissection (ALND), which was necessary given the patient’s lymph node involvement at diagnosis. Robotic surgery, utilizing the da Vinci system, offers unmatched precision, enabling the surgeon to navigate intricate areas with greater accuracy, and reducing the risk of nerve and tissue damage. The same incision was used for both the mastectomy and lymph node dissection, minimizing scarring. The entire surgery happened using 5 cm wound.
The robotic approach also offered other notable benefits, including a reduction in blood loss, less postoperative pain, and a faster recovery time compared to traditional mastectomy methods. The patient was discharged shortly after surgery, experiencing minimal discomfort, and was able to resume her normal activities sooner than expected. Following surgery, she began radiation therapy as a precautionary measure to eliminate any residual cancer cells and reduce the risk of recurrence. Radiation therapy is commonly used after surgery in breast cancer.
This pioneering case demonstrates the immense potential of robotic nipple-sparing mastectomy for patients with early breast cancer and for patients with genetic risk of breast cancer (BRCA+) who have a higher risk of breast cancer. The innovative use of the robotic NSM technique, along with immediate reconstruction using the LD flap, provided the patient with excellent cosmetic results, reduced recovery time, and peace of mind. Unlike traditional mastectomy techniques, where aesthetic outcomes are often compromised, robotic NSM preserves the physical appearance of the breast, which can greatly enhance a patient’s emotional well-being following treatment. This combination of oncological success and aesthetic preservation sets a new precedent for breast cancer treatment in India, offering women a more comprehensive and minimally invasive option in their fight against cancer.
As robotic surgical techniques continue to evolve, more patients can benefit from these advances. The precision offered by robotic systems enables surgeons to handle complex cases with better outcomes, reducing the risk of complications and enhancing patient satisfaction. The use of robotic NSM in this case highlights the importance of personalized cancer treatment, where each decision—from neoadjuvant therapy to reconstruction—is tailored to the individual’s medical and emotional needs. This landmark procedure paves the way for future innovations in the field, making cancer treatment in Bangalore and India a viable option for patients seeking advanced and effective medical solutions.
About Dr. Sandeep Nayak
Dr. Sandeep Nayak, one of India’s leading surgical oncologists, and the Founder and Chief of Surgical Oncology at MACS Clinic, Bangalore, is globally recognized for his expertise in minimally invasive cancer surgery.
Dedicated to providing ethical, evidence-based, and innovative treatment options, Dr. Nayak ensures the highest standard of dependable care. His unwavering passion for advancing cancer treatment continually improves patient outcomes and sets new benchmarks in oncology.
For further details, Contact Dr. Sandeep Nayak –
MACS Clinic,
42nd Cross Rd,
8th Block, Jayanagar,
Bengaluru, Karnataka - 560 070
Email: support@macsclinic.com
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